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Patients in delirium require trustful communication and re‐orientation. We developed a flyer with positive, re‐orientating suggestions for families of delirious patients in intensive care units. Suggestions include creating a safe environment, interpreting unusual behaviours positively and fostering mental resilience. Additionally, families are encouraged to prioritize their own well‐being, recognizing their crucial role in supporting their loved ones. This flyer offers practical strategies across four key areas: ensuring security and orientation, reframing noises and body experiences, managing agitation and reshaping perceptions. By equipping families with knowledge and tools, this resource aims to promote understanding, resilience and strength to humanize delirium care. [ABSTRACT FROM AUTHOR]

The article provides information on the advancements and importance of rehabilitation in pediatric and adult intensive care units (ICUs). It discusses the physiological principles guiding rehabilitation interventions, the challenges in delivering rehabilitation, and the need for individualized and tailored approaches. The article also emphasizes the role of teamwork, engagement of patients and their loved ones, and the ongoing nature of rehabilitation beyond the ICU.

Background: Delirium is a common complication in patients in Intensive Care Units (ICU). Interventions such as mobilization are effective in the prevention and treatment of delirium, although this is usually completed during the daytime. Aim: The aim of this study was to assess the feasibility of mobilization in the evening to prevent and treat ICU patients from delirium by an additional mobility team over 2 weeks. Methods: The design was a pilot, multi‐centre, randomized, controlled trial in four mixed ICUs over a period of 2 weeks. The mobility team consisted of trained nurses and physiotherapists. Patients in the intervention group were mobilized onto the edge of the bed or more between 21.00 and 23.00. Patients in the control group received usual care. The primary outcome parameter was the feasibility of the study, measured as recruitment rate, delivery rate, and safety. Secondary outcomes were duration and incidence of delirium, mortality, duration of mechanical ventilation (MV), and hospital length of stay for 28 days follow‐up, and power calculation for a full trial. Results: Out of 185 patients present in the ICUs, 28.6% (n = 53) were eligible and could be recruited, of which 24.9% (n = 46, Intervention = 26, Control = 20) were included in the final analysis. In the intervention group, mobilization could be delivered in 75% (n = 54) of 72 possible occasions; mobilization‐related safety events appeared in 16.7% (n = 9) without serious consequences. Secondary parameters were similar, with less delirium in the intervention group albeit not significant. With an association of Cramer's V = 0.237, a complete study reaching statistical significance would require at least 140 patients, last 6 weeks, and cost >30 000 €. Conclusions: In a mixed ICU population, mobilization in the evening was feasible in one‐quarter of patients with a low rate of safety events. Future trials seem to be feasible and worth conducting. [ABSTRACT FROM AUTHOR]

BACKGROUND Early mobilization of patients in intensive care units (ICUs) improves patient recovery, but implementation remains challenging. Protocols may enhance the rate of out‐of‐bed mobilizations. AIM: To evaluate the effect of implementing a protocol for early mobilization on the rate of out‐of‐bed mobilizations and other outcomes of ICU patients. STUDY DESIGN Multicentre, stepped‐wedge, cluster‐randomized pilot study. METHODS: After a control period, five ICUs were allocated to the implementation of an inter‐professional protocol for early mobilization in a randomized, monthly order. Mobilization of ICU patients was evaluated by monthly 1‐day point prevalence surveys using the ICU Mobility Scale. The primary outcome was the percentage of patients mobilized out of bed, defined as level 3 on the ICU Mobility Scale (sitting on edge of bed) or higher. Secondary outcomes were mechanical ventilation, delirium and ICU‐ and hospital‐days, as well as unwanted safety events. RESULTS: Out‐of‐bed mobilizations increased non‐significantly from 36·2% (n = 55) of 152 patients during the control period to 45·8% (n = 55) of 120 patients during the intervention period (difference 9·6%; 95% confidence interval −2·1 to 21·3%). Of 55 mobilized patients per group, more patients were mobilized once per day during the intervention period (intervention: n = 41 versus control: n = 23 patients). Multiple daily mobilizations decreased (control: n = 32 control versus intervention: n = 14 patients). Secondary outcomes, such as days with mechanical ventilation, delirium and in ICU and hospital, did not significantly differ. Adherence to the protocol was >90%; unwanted safety events were rare. CONCLUSIONS: Implementing a protocol for early mobilization of ICU patients showed a trend towards more patients being mobilized. Without additional staff in participating ICUs, a significant increase in ICU mobilizations was not to be anticipated. More research should address whether more staff would increase the number of frequent mobilizations and if this is relevant to outcomes. RELEVANCE TO CLINICAL PRACTICE: Implementing inter‐professional protocols for mobilization is feasible and safe and may contribute to an increase of ICU patients mobilized out of bed. [ABSTRACT FROM AUTHOR]

Background: Diaries written for patients in the intensive care unit (ICU) are offered in many European countries. In Austria, ICU diaries have been relatively unknown, but since 2012, they have started to emerge. Aim: The aim of this study was to explore the extent and application of ICU diaries in Austria in 2015. Method: The study had a prospective multiple methods design of survey and interviews. All ICUs in Austria were surveyed in 2015 to identify which ICUs used diaries. ICUs using diaries were selected for semi‐structured key‐informant telephone interviews on the application of ICU diaries. Interviews were analysed by content analysis. Results: Of the 178 ICUs contacted, 13 had implemented ICU diaries. In all ICUs, diaries were sporadically introduced by a few dedicated nurses. Experiences of participating nurses can be summarized in two main themes: (a) the process of innovation and (b) the process of practice. Sub‐themes were: (i) inspiration, creativity and innovation and (ii) purpose, indications, responsibility, authorship, experience, negative reception, and post‐ICU practice. Individual nurses at each ICU found ways to organize and format ICU diaries while dealing with ambivalence and legal implications. Conclusion: The implementation of a new nursing intervention is an ongoing process. Being innovative and responsible can be challenging, especially in hierarchical team structures. We recommend that nurses work towards national standards for the diary concept in order to enable future research into the process and outcome of ICU diaries. Relevance to Clinical Practice: The implementation of ICU diaries in routine care requires an ongoing adaptive, reflective process. Nurses may experience innovation, leading to the development of their own, feasible adaptions and structures. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims and objectives To compare international literature on the detection of complications associated with early mobilization of mechanically ventilated patients in intensive care units ( ICUs). Background Early mobilization of mechanically ventilated ICU patients is considered to be a more beneficial approach to treatment in intensive care; however, it remains unclear how safe this approach is and what complications to expect. Search strategies A systematic literature research in English and German was conducted in June 2013 in the databases Pubmed, CINAHL, Cochrane library and MedPilot without limiting by year of publication. References of the included studies were screened and supplemented by manual search. Inclusion and exclusion criteria Inclusion criteria were studies about mechanically ventilated adult patients on ICU, who were mobilized and reported complications. Excluded were studies that (a) did not differentiate between non-ventilated and ventilated patients, (b) did not report complications and (c) focused on in-bed mobilization. Conclusions Of 952 titles, 16 articles fit the criteria including 3 reviews and 13 clinical trials. The percentage of complications in clinical trials ranged between 0% and 16%. In total, 453 patients were mobilized 3613 times (up to walking with ventilation) with a complication mean rate of 3·9% ( n = 144) using the inherent safety limits. No fall, cardiac arrest, or death was reported. Most complications were pulmonary, followed by haemodynamic ones. Serious complications that led to further consequences were observed in 0·3% ( n = 10) of all mobilizations. The clinical studies have been carried out in trained, interdisciplinary teams with most of them using adapted algorithms for safety. Relevance to clinical practice Despite a low complication rate, a frame for safety during early mobilization including team training and adapted criteria is recommended. [ABSTRACT FROM AUTHOR]